Viability of an ENN research initiative

The Quality Project is an operational research programme implemented by Groupe URD in partnership with a network of non-governmental organisations (NGOs) and researchers, and involving a team of specialists in public health, nutrition, habitat/shelter, food security, international humanitarian law, and quality assurance. It aims at developing, testing and disseminating a self-evaluation and self-learning tool based on a questioning process throughout the project cycle. The ultimate objective of the 'tool' is to improve the service provided to beneficiaries.

In order to ground this tool in 'field' reality, the Quality Project team is carrying out missions in Central America, Afghanistan and the Gulf of Guinea with the aim of capitalising on, and learning from, aid workers' experiences, in various sectors and humanitarian contexts. A participatory approach is used, combining direct observation and project visits with interviews and focus group discussions with agency staff, national officials and beneficiaries. Feedback seminars are organised in the field and in Europe after each mission.

Two of the missions in Afghanistan have already taken place, in July/August 2002 and January/February 2003. These research missions were multi-sectoral and involved a wide range of actors (local and international NGOs, government representatives, United Nations organisations.). Areas visited included Kabul, the Shamali Plain, the Panshir Valley, the central (Bamyan), northern (Ruyi-Duab, Mazar-e-Sharif Nahrin, Pul-e-Khumri), southern (Kandahar) and eastern (Jalalabad) parts of Afghanistan.

The purpose of the field missions was to gain a thorough understanding of the range of humanitarian interventions and strategies, to identify what made projects successful or problematic, to raise issues pertaining to the quality of humanitarian interventions and stimulate a debate with agencies and key stakeholders. This summary concentrates on the nutrition sector, in light of findings in the health and food security sectors.

The nutritional situation in Afghanistan can be summarised as one of high rates of chronic malnutrition (50-60%) and micronutrient deficiencies, related to chronic food insecurity and poor dietary diversity, and relatively low rates of acute malnutrition (<10%). Acute malnutrition is usually associated with disease (notably diarrhoea) and improper infant feeding practices.

Harvest in Ruy Doab

During the first mission (August 2002), field interventions seemed mostly supply-driven and relief-oriented, with a reliance on blue-print programme design (e.g. supplementary and therapeutic feeding programmes). Factors which contributed to this situation included the felt urgency to respond to the drought and effects of the conflict, donor pressure to yield measurable outcomes, competition between agencies for funds and visibility, and lack of staff with nutritional expertise and knowledge of Afghanistan. Needs assessment tended to rely essentially on quantitative data (e.g. nutritional surveys), to the detriment of qualitative information on food security, health and caring practices, and there was little consultation of potential beneficiaries.

Observed high rates of defaulters, low weight gains, and low recovery rates suggest that 'classical' nutritional interventions - supplementary feeding centres (SFCs), in particular - may not be an appropriate response in the Afghan context. Furthermore, difficulties in implementation of therapeutic feeding centres (TFCs) led agencies to resort to the distribution of Ready-to-Use Therapeutic Foods for use at home with little or no monitoring, although the effectiveness of these products is not yet proven outside TFCs nor in the absence of regular supervision1. Finally it seemed that monitoring rarely involved consultation of beneficiaries and was often insufficient or inadequate to inform decisions on strategy change2.

These difficulties must not overshadow the impressive efforts made at the national level to address the structural causes of malnutrition through long-term strategies. The second mission (January 2003) highlighted how nutrition coordination, under the leadership of the Ministry of Health (MOH) and UNICEF, has played a key role in lesson learning from experiences in 2001/2002. Efforts are concerted into local capacity-building, a critical evaluation of SFCs is under preparation, management strategies for severe malnutrition are being integrated into MOH structures, and a national food security and nutrition surveillance is yielding its first results, in co-ordination with key ministries. Surveys are underway on feeding and caring practices, and non-food approaches are being considered.

The key to addressing malnutrition lies precisely in coordination, and in a strategy integrating the health and food security/agriculture sectors. These sectors, though, face similar constraints to those encountered by the nutrition sector, and the same weaknesses have been noted (supplydriven approach, little consultation...).

In health, key issues such as health beliefs and health-seeking behaviours were poorly understood, though understanding them is essential to improve health education and to develop community health strategies. Constraints included difficulty in accessing women and the lack of qualified staff, in particular female staff and in remote areas. Also, the lack of clarity concerning the future MOH's mandate and activities made it difficult for NGOs to work with, rather than as substitutes for, the government. In the food security sector, the main constraints were lack of understanding of agrarian systems (seed security, pastoral livelihoods, rain-fed systems, etc.), and poor knowledge of food and economic security and coping strategies in urban areas, which were growing rapidly with the flow of returnees and internally displaced persons (IDPs) fleeing drought-struck regions.

Humanitarian actors in Afghanistan are faced with challenges of emergency situations (IDPs, drought), reconstruction (local capacitybuilding) and development (long-term strategies), often with short-term means in terms of funding and human resources. These challenges are made more difficult by constraints such as the shortage of qualified human resources (few international and national staff have training and experience in nutrition, and much of the expertise is concentrated in Kabul) and a high rate of staff turnover, that makes it difficult to capitalise on lessons learnt and follow through a coherent strategy. Furthermore, the complexity and diversity of the current political and humanitarian situation makes it difficult for agencies to place themselves on the emergency-rehabilitationdevelopment continuum, and to design strategies accordingly.

Significant progress has been made but while the world's attention is turned to Iraq, we can only hope that Afghanistan will not be forgotten and that current achievements do not collapse.